Red Blood Cell Distribution Width Is a Predictor of Readmission in Cardiac Patients. Issue 5 (28th March 2013) - Ephrem, Georges
Abstract Background Three‐quarters of rehospitalizations ($44 billion yearly estimated cost) may be avoidable. A screening tool for the detection of potential readmission may facilitate more efficient case management. Hypothesis An elevated red blood cell distribution width (RDW) is an independent predictor of hospital readmission in patients with unstable angina (UA) or non–ST‐elevation myocardial infarction (NSTEMI). Methods The study is a retrospective observational cohort analysis of adults admitted in 2007 with UA or NSTEMI. Data were gathered by review of inpatient medical records. The rate of 30‐day nonelective readmission and time to nonelective readmission were recorded until November 1, 2011, and compared by RDW group using the 95th percentile (16.3%) as a cutoff. Results The median follow‐up time of the 503 subjects (average age, 65 ± 13 years; 56% male) was 3.8 years (interquartile range: 0.3–4.3 years). Those readmitted within 30 days were older, had more comorbidities and higher RDW and creatinine levels, and were more likely to have had an intervention. At 3.8 years of follow‐up, subjects with high RDW (>16.3%) were more likely to be readmitted compared to those with normal RDW (≤16.3%) (72.28% vs 59.95%, P = 0.003). In multivariable analyses, high RDW was a statistically significant predictor of readmission in general (hazard ratio: 1.35 (95% confidence interval [CI]:1.02‐1.79), P = 0.033) but not of 30‐day rehospitalization (odds ratio: 1.34 (95% CI: 0.78‐2.31), P = 0.292). Its area under the receiver operating characteristic curve was 0.54 (sensitivity 23% and specificity 85%). Conclusions An elevated RDW is an independent predictor of hospital readmission in patients with UA or NSTEMI.